低血糖脑病的临床和神经影像学特点

Clinical and neuroimaging features of hypoglycemic encephalopathy

目的探讨低血糖脑病(HE)的临床和神经影像学特点。方法回顾性分析49例HE患者的临床和神经影像学资料。结果本组HE患者临床表现为意识障碍26例,精神行为异常19例,癫发作6例,言语不清、反应迟钝10例,偏瘫和单肢瘫5例,去脑强直发作3例。23例行头颅CT检查,除10例见有脑梗死和脑萎缩外余无异常改变。13例行MRI检查,7例异常,其中显示弥漫性皮质和海马受累者3例(2例同时波及基底节区,1例仅累及右侧大脑皮质,MRS示病变区乳酸峰无明显异常),胼胝体压部受损2例(1例患者10d后病变恢复,1例伴内囊后肢受累),壳核和放射冠区白质受累各1例,表现为等或稍长T1、长T2异常信号,DWI呈高信号伴表观扩散系数(ADC)降低。结论HE的临床表现多不典型;MRI有高度特异性,DWI序列对病变更敏感。

Objective To investigate the clinical and neuroimaging features of hypoglycemic encephalopathy（HE）.Methods The clinical and neuroimaging data of 49 HE patients were analyzed retrospectively.Results Among all the HE cases,26 cases had conscious disturbance;19 cases had spiritual and behavior disorder;6 cases had epileptic seizure;10 cases had inarticulate speech and diminished response;5 cases had hemiplegia or monoplegia;3 cases had decerebrate rigidity seizure.There was no abnormalities except 10 cases with cerebral infarction or cerebral atrophy in the 23 cases scaned by CT.In 13 cases scaned by MRI,7 cases were found abnormalities.3 cases of them had abnormalities of the diffusive cerebral cortex and hippocampus（2 cases had widespread involvement in the basal ganglia,1 case only involved unilateral cortical,and MR spectroscopy revealed no evidence of abnormal lactate in the affected cerebral cortex）;2 cases of them involved in the splenium of corpus callosum（1 case recovered 10 d later,and 1 case spreaded to posterior limbs of the internal capsule bilaterally）;1 case of them involved in the putamen;and the other case was involved in the corona radiata.There were isointense or hypointense abnormalities on T1WI and hyperintense abnormalities on T2WI and DWI in the lesions,with the value of apparent diffusion coefficient（ADC）reduced.Conclusions There is no specific clinical manifestation in HE.MRI reveal highly selective lesions in HE.DWI is more sensitive than conventional MRI to define the lesions.